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Home My WebLink AboutSHEETS LT 7MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211233 Work Type: SepticTank Upgrade Tax Code Number: 05106268000 Site Legal Address: SHEETS LT 7 G:1461 Site Mailing Address: 24019 PILLOW CIR, Chugiak Owner: ALEXANDER CHERILYN A D Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: t»enr S Uehartment 6/24/2021 6/24/2022 24418 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: Date: 6 9 MUNICIPALITY OF ANCHORAGE Community Development Department - Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-062-68 Property owner(s) Alexander, Cherilyn Day phone (720) 384-5970 Mailing address 24019 Pillow Circle, Chugiak, AK 99567 Site address 24019 Pillow Circle, Chugiak, AK 99567 Legal description (Sub'd., Block & Lot) Sheets L7 Legal description (Township, Range & Section) Lot Size 24,418 Sq. Ft. Number of Bedrooms iJJ APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ElUpgrade ❑x Duplex (D) ElHolding Tank F1Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: N/A Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22-5 Waiver Fees: _ Date of Payment: Ro� Z,2 i' Date of Payment: Receipt Number: 00--'),411-3 Receipt Number: Permit No. OSP 2-1 /2 3:3 Waiver No. Permit App__- : - : June 22, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 6/22/21 Subject: Sheets L7 – 24019 Pillow Cir Septic tank replacement Dear On-Site Services Engineer: The septic tank on the subject lot is nearing the end of its useful life, and the owner would like to proactively upgrade to a new septic tank. We are submitting this permit application for its replacement. The property is serviced by a private well that is located greater than 100’ from the proposed tank location. The neighboring lots are serviced by a community well that is located greater than 200’ from the proposed tank location. Therefore, no conflicts exist between the proposed tank location and any other well or septic system, on this lot or adjacent lots. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impact to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211233, Deb Wockenfuss, 06/24/21 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' REMOVE EXISTING TANK PER UPC CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND SHEETS SUB, LOT 7 FEET 0 50 100 NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. PILLOW CIRCLE 2-BDRM HOME 10' UTILITY EASEMENT INSTALL NEW 1000 GAL TANK W/20" MANWAY EXISTING ABSORPTION TRENCH TO STAY IN SERVICE 6/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211233, Deb Wockenfuss, 06/24/21 Municipality of Anchorage Page 1 __of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SN990156 PIDNumber: 051 -062-68 ~ame: MM&M Contracting Wastewater System: ~ New [] Upgrade AddreSS:p.o. BOX 670495 Chugiak, AK 9956 ABSORPTION FIELD NO. of Bedrooms: Phone; 688-1236 Three X3 Deep Trench [] Shallow Trench rnBed []Mound [3Other LEGAL DESCRIPTION Soil Rating: . 8 GPD/Sq. Ft. I Total Depth from1 1 original. 5 ' grade: Lot: 7 Block: S u~JlV~ ~r~ S Depth 1o pipe bottom from 0?ginal grade: G ravel depth beneath pipe 3 o 5 Ft. 8 i Ft. Township: I Range: I Section: Fill added above original grade: Gravel length: Ft. 3 6 ~ Ft. WELL: [~ New [] Upgrade Gravelwidth: 3 ' Ft. Numbe,~of lines: DislaacebetweerHine~:_ Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Private 102 ~ Ft 101 ' Ft. 576 SO. Ft. ASTM D3034 PVC -- Date Drilled: StaticWater Level: installer: Date installed: 9 / 1 / 99 Driller: Sullivan 6/22/99 58 ' Ft MM&M Contractin( Yield: Casing Height ~Above Ground: 3 0 GPM I P"'~P S~t a,: Ft, 2 Pt.TAN K SEPARATION DISTANCES X~ Septic [3 Holding [] S.T.E.P. To Septic Absorption Lift Holding ~ublic/PriYateManufacturer: Capacib/in gallons: We~h >100' >100' N/A N/A N/A Steel Sudace >100' >100' N/A N/A N/A LIFT STATION - N/A LOt > 5 ' > 10 ' N/A N/A N/A- Sizein gallons: I Uanufacturen Foundation >5' >10' N/A N/A N/A "Pump on' leve] at:' I "Pump off' level at: i High water alarm at: I Remarks: BENCH MARl( Assumed Elevation:1 0 0 . 0 ENeLNgA¢AS~L Inspections pedormed by: Depadment of Health and Human Se~ices approval Reviewed and approved by: ~ ~/ /~/, ~Date: /o' ~- ~ 9 72-013 (Rev. 9/91) MOA 25 Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW990156 PID No. 051-062-68 C3S2 S1 C4 TH1 Cl Two Bedroom Home TH2 %lternate Site Well P/LLo / C/ROLE PLAN AS-BUILT SCALE 1" = 30' A B S1 14.3 40.0 S2 17.3 40.5 C3 20.9 41 . 1 C4 51.5 60.9 M1 47.6 59.2 Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 Anchorage, AK 99519-6650 343-4744 On-Site Wastewater Disposal System or Well Inspection Report Permit Number SW990156 PID No. 051-062-68 94.2 98.3 1,000 Gallon Tank 94.1 97.0 Geotextile Fabric 9~ ~,8~ ~ cjg_ 83 Drainfield Rock ~ 85.9 79.0 I PROFILE AS-BUI HORIZONTAL SCALE 1" = 10' NO VERTICAL SCALE FROM : MMM CONTRACTING PHONE NO. : 6881238 Sep. 29 1999 09:10AM P2 .......... --' ..... . . :: :...?.:.., ,. ~ :, . . '.' P,':: 5 ' . ., ':',.Y:5..::':~i':F: :,.. . :{ '~))'~'~ ':'~.t~,<,: ..... .. ''~ .~,.':%:.'.. ~: x?'Jl/A~C{..7~: ........... ' ........... [''s '" ......... ?'.."" · . .:: : .:.. i:.: ,:.: . ... "",:~ .oO~*~;~db~'.:': ~ ': · ' · :: · ;:~':~ ':': :.:..:> .' 5ULLI VAN :.WATER OWNER OF LAND.~.N_,; /~. ADDREBS LEGAL bESORIPTION ~/~'T',~ PERMIT NUMBER ?__~_,/~. Date of Issue ~ .-J¢_-2.~' TAX INDENTIFIOATION NUMBER D,'~I ' O6~- ~¢ I~ well Iooated at approved permit Io~atlen? ~ ~ No Method of Ddllln0: ~aW ~ cabl~ tool O~plh of wail: '/~ ~ O.~lfig Type ~_.WellThloknes~ ~ .~O inche~ Diameter ~ /( inches, depth_ /O,~ ...... feet Liner Type;: ~ 5~¢ Casing Stlckup Above Ground: ~ feet Stati~ Water Level (from ground level); ~ feet Pumping level ......... feet affer~_hgs, pumping ..... gpm Recover Rate: ~ O gpm Method of Testing: .~ I ~ Well Intake Opening Type: ~en End '~ Open Hole ~ Screened; Stad feet Stopped feet ~ Pedoratlons Stad ,.]SPt~topped ,feet Depth: from O rfC'et, to ~ feet Pump intake Dap[h: feet Pump Size ,hp Brand Name Well Disinfected Upon Completion? ~e8 ~ No Method,of Disinfection: ~ ~ ~/J~ ~ 0 ~ HOLE DATA DEPTH t'.%, L; I v t.b/ OCT 5 1999 Municipality et Anch,orage Dept, Health & Human Services ...... ............. D~,lo~s N~e. ATTENTION: It lo the m~ponsibility of the properly owner to submit a ~py of the well log to tho proper au{ho~. Munlclpall~ of Anchorage: Depadment of Health & Human Se~icea and/or Depa~ment of Environmental Conse~atlon, MatSu Borough: Depa~ment of Environmental ConseNatlon. Received Time Sep,29, 9:01AM MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 ¢07) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jun 18, 1999 Expiration Date: Jun 17, 2000 Permit Number: SW990166 Legal Description: SHEETS LT 7 Design Engineer: 0014 Anderson Engineering Owner Name: M M & M Contracting Owner Address: PO Box 670495 Chugiak, AK 99567- Parcel ID: 051-062-68 Site Address: Lot Size: 24418 SQ. F'f'. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( t 8AAC72 ) and Drinking Water Regulations ( 18AACS0 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 houm ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: June 10, 1999 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 7, Sheets Subdivision Septic System Design Impacts to Adjacent Properties Dear Onsite Services Engineer: The owners of Lot 7, Sheets Subdivision intend to oonstruet a two bedroom home on the lot at the location shown on the attached Site Plan. The septic system, however, will be sized for a three bedroom home. The lot is currently served by a community water system which currently out of compliance with ADEC and apparently poorly maintained. They therefore intend to construct a well on the lot to serve the house. The plat for the subdivision has been researched and contains nothing indicating individual wells are not allowed in the subdivision. We are hereby requesting a permit to construct a well and septic system on the lot at the locations shown. Testholes placed on the lot revealed poorly graded to well graded gravel with some silt. Percolation tests performed indicated a rate of 10 to 12 minutes per inch. No groundwater was encountered nor was any noted during the ensuing monitoring period. We have therefore designed a deep absorption trench with an effective depth of 8'. The distribution pipe will be placed at 3' below the surface and the total depth of the system will be 11.5'. The slope of the lot is fairly flat with only aslight grade from the north to the south. All other lots in the area are served by the community water system and no conflicts exist with the new well radius and any of the adjoining septic systems. Most of the radius is contained on the lot and within the road right-of-way. Lot 7, Sheets Subdivision June 10, 1999 Page Two if the 1. system is constructed as designed the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. The system, if constructed as designed, impact on reserved space, either surface located in the area. will have no adverse or subsurface, on any lots The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments LOT 1 Area LOT 2 Septic Area LOT 3 I 36' Long X 3' I Eff TH1 _l Wide x 8' Absorption Trench 1,000 Gallon Septic Tank .ternate Site TH2 Two HOme / / / Area / / / / LOT 5 vacant NOTE: Well No. Conflicts wi O~ Wells or Septic \ Systems in the Area.. LOT 6 eptic SITE PLAN SCALE 1"= 40' LOT 7, SHEETS DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom System Deep Trench System Perc. Rate: 10 - 12 Min./inch 1,000 Gal. Septic Tank Application Rate: .8 GPD/SF 8' Drainfield Rock 3 Bedrooms X 150 GPD / .8 GPD/SF = 562.5 SF of Absorption Area 562.5 SF/16 SF/ LF of Trench = 35.1 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 36' in Length with 8' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface. Total Depth to be 11.5' from Original Ground. ///~'~//J ~~ Natural 3' I '4 Backfill - I ~ F/__ __ Geotextile ~" ~~"' ~. o~ ~ '~ PVC (Slots Down) 8' '' ~ ~ ~Drainfield Rock 3' NOTE: Minimum 4' From Groundwater. Maintain 10' Separation From Lot Line. TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. 2 3 5 6 ? 8 10 11 Lot 7~ Sheets Subdivision ';2 13 14 15 16 17 18 19- 20 PT/OL DATE PER COMMSNTS Perc. TESTHOLE NO. 1 GW With Silt Bottom of Hole SLOPE WAS GROUND w ATF..R SITE PLAN S~e ~i~e ~l~n I J ii IF Y~S. AT WHAT None I~.:6/9/99 /O PERGOLA'TION R/,.T5 /~ Irnmu~,,mcn) P=..RC HOL5 DIAMETER _ ~" Cavity presoaked prior to testing. PERFORM=-D BY: _ I TIFY THJ, T THIS %;~.~T W;~5 p~J.qFORMSD Ih Michael E. Anderson -.// _ ACCORDANCS~THA~STATSANDMUNICIPALGUID~INEStNSFFSCTONTH~SDAT~ DA7~_ 6////~ ? 9 10 11 14 16- 1'7 18 19 2D Municipality of Ancho~g.e DEPARTMENT OF H~TH & HU~N SERVICES 8~ "L- StreeL Ancho~ge. AI~ ~02~ SOILS LOG -- PERCO~ON ~ST Lot 7, Sheets Subdivision DATE PERFO; PT/OL TESTHOLE NO. 2 GW With Silt Bottom of Hole LII I I1¢ FII III III I II WAS GROUND WATE~ ENCOUNTERED? IF YES, AT WHAT None Reading No /:/o ~:~0 SITE PLAN I III I s~e ~i~e ~14n I' -! I 3'0 P=.RCOLATION RAT=. /~ (mmtnc:s/mc~) PF. RC HOLE. DIAMETER TE..~T RUN BETWF. EN ' ~/ FT AND ~'-- FT Perc. Cavity presoaked prior to testing. Michael E. Anderson '~;/~ ACCORDANCE V~TH ALL S;ATE AND MUNICIPAL BUIDE/.IN[5 IN C-FFECT ON 7H15 DATE. DAT=' GREATER ANCtlOI<AGI:: ARI_A iJOROUG,, L)epartlnent of [nvironmental QualiE.y 3330 "C" Street Anchorage, Alaska 99503 S()II,S I,OG I)F,I'~OI,ATION 'I'I,],'4T Performed for ..... _~.~,~t~G_._C~.~___~.~_C~)~kJ_~_~.~_t!,~_G ........... ;)ate Perfort~,e:J Legal Descri pti on: ......... 1~_..-'K .......... ~-~ ..... ~_L)~Ik)~L~Jk) This form reports: Soils log~ ..................... Percolation ~est Del)~h Feet 3~ zl - 5- 7- 8- 9- 10- ll - 12- 13- Was ground water encountered? __~.~_.O~ ..... If ,yes, at wilat depth? Reading Date Gross Time Net l'ime ?e_pth__t_'_o__W~ate___r- Net i)rop Percolation rate minute. · Proposed installa~i~h-:-gb~a~te Pit Drain Field ~. ~ Oept'n'- ' or trench • • tc. Municipality of Anchorage °'4"'i'• }e. , ,rfi1t�r ',ri_ On-Site Water and Wastewater Program : `'' (907) 343-7904 ®t�E,Y Certificate of On-Site Systems Approval Parcel I.D. 0 1 -Ob Expiration Date: J 2 - 7 1. GENERAL INFORMATION Complete legal description �► E t S LOT 7 Locatiton (site address)' _ q 0l cr ?:IL-1--co c- - Current Property owner(s) 1L-°`'`/`!n/E COA,e,T fRL �Si!/Day phone 74 CS'' Mailing address . Real Estate:Agent Day phone ��8 -S_70 ;, 2. TYPE OF DWELLING: , / t n g Sin jl+�•F8rnlly (w/wo ADU) a AUG �, g al/ s ❑ Duplex ti ❑ Multiple Dwellings (Single Family and/or Duplex) �Q _---1-> � 3. NUMBER OF BEDROOMS: 3 `�6 3 L 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well g Individual Fr Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by- - Date: q/(/1 7 COSA to be r' -a y-•• o the engineer,unless otherwise requested by the engineer. COSA Fee $ -a L, Waiver Fee $ Date of Payment V 3 ! Date of Payment Receipt Number CW3lb Receipt Number COSA# &SC -1375 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm C-1/11 6: if/ EP,}--/1,- Phone -S SSQ� Address /� Engineer's Printed Name (/,r WfC2- t,5 -q-G 2,1}t2,..'NL' Date (7.&,‘" 17 ..... OF Al • • 49T = ♦ 6. DSD SIGNATURE }� ♦ • • r• 1`' System#1 Approved for 3 bedrooms C +�es:G�:°8a•�•lzarini ; �+ :. System#2 Approved for bedrooms �•41 ••••CE-13854 •• • .• *'� Disapproved I;%pEsStP'i Conditional approval for bedrooms, with the following stipulations: : 0 ANCf�� VAP-o�R�P.� _ 10 CIO • 'tel"Ni Su- By: '� (�— P --� Original Certificate Date: t — / 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet c • c If more than 1 septic system is on the lot: COSA Checklist# 1 of1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: SHEETS LOT 7 Parcel ID:051-062-68 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 6/22/99 Sanitary seal (Y/N) Y Wires properly protected (Y/N)Y Total depth 101 ft. Cased to 101 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 6/22/99 8/18/17 Static water level 58 ft. 64 ft. Well production 30 g.p.m. +7.9 g.p.m. WATER SAMPLE RESULTS: Coliform f i) colonies/100 mL Nitrate �ci • 4 mg/L D Arsenic A/ l) ug/L Date of sample: / X16 /I7 Collected by: C&M ENGINEERING B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/1/99 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping O 0,5/17 Pumper 5P^t17i4Ry rh i,1 S C. ABSORPTION FIELD DATA Date installed 9/1/99 Soil rating (g.p.d./ft2 0tibigears) 0.8 System typeTRENCH Length 36 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 11.5 ft. Eff. absorption area 576 ft2 Monitoring tube Y Depression over field N Date of adequacy test 8118117 Results (Pass/Fail)PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date N/A D. LIFT STATION Date installed -- Size in gallons -- Manhole/Access (Y/N) -- "Pump on" level at-- in. "Pump off' level at -- in. High water alarm level at -- in. Datum -- Cycles tested -- Meets alarm&circuit requirements?-- E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot +100 On adjacent lots +100 Absorption field on lot +100 On adjacent lots +100 Public sewer main +100 Public sewer manhole/cleanout +75 Sewer/septic service line +50 Holding tank +75 Animal containment areas +100 Manure/animal excrete storage areas +100 SEPTIC/HOLDING TANK ON LOT TO Building foundation +5 Property line +5 Absorption field +5 Water main +10 Water service line +10 Surface water +100 Wells on adjacent lots+100 ABSORPTION FIELD ON LOT TO: Property line +10 Building foundation +10 Water main +10 Water Service line+10 Surface water +100 Driveway, parking/vehicle storage +10 Curtain drain +50 Wells on adjacent lots +100 F. COMMENTS LEACHFIELD PRE-SOAKED WITH +2K GALLONS PRIOR TO TEST G. ENGINEER'S CERTIFICATION OF AL.1-1.1.1 t��‘l • I certify that J have determined through field inspections and .,r. ` ' : review of Municipal records that the above systems are in !'r C-3 • •'ST conformance with MOA COSA guidelines in effect on this date. * a,1' 9T '_ . M ! Engineer's Printed Name CHARLES BALZARINI • ' • ` " Date 8/20/17 ' fit HA" ES G BALZARINI (a• .e CE-13854 4"7 V7,20v1.7 PROFESSn COSA canary sheet_2-6-15.doc · ~ MUNIC] PALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I,D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 051-062'-68 GENERAL INFORMATION Complete legal description Lot 7, Sheets Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address MM&M Contracting· P.O. Box 670495 Chugiak, Day phone. AK 99567 688-1236 Day phone Day phone Unless otherwise requested, HAA will beheld, f(~r pickup. NUMBER OF BEDROOMS: Three ( 3 ) TYPE OF WATER SUPPLY: XXX Individual well Community well Public water ' "' NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system.. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my invest!gation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein, t further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date Of this inspection. NameofFirm Anderson Engineering Address P.O. BOX 240773 Anchoraqe, AK 99524 Engineer's signature ~'~"~., (~ ~ Phone Date 522-7773 10/4/99 DHHS SIGNATURE // Approved for "T~ ~. j~ ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesyto pumhasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections o,r,.analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ' Municipality of Anchorage OCT 04 3999~ DEPARTMENT OF HEALTH & HUMAN SERVICF~NIo~Au. ,~ Environmental Services Division ENVIRONMENIA~-S~-~v,~,.~,, 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Private Log present (Y/N) Total depth 102 ' Sanitary seal (Y/N) Health Authority Approval Checklist Lot 7, Sheets Subdivision ParcelI.D,: 051-062-68 Y If A, B, or C, attach ADEC letter. ADEC water system number Date completed 6 / 22 / 99 Cased to 101 ' Casing height (above ground) 2 ' Y Wires properly protected (Y/N) Y AT INSPECTION FROM WELL LOG 6/22/99 Date of test Static water level 58 ' Well production 3 0 WATER SAMPLE RESULTS: Coliform 0 Date of sample: __ 9 / 2 9 / 9 9 B. SEPTIC/HOLDING TANK DA'rA Date installed 9 / 1 / 9 9 Foundation cleanout (Y/N) Date of Pumping _ New C. ABSORPTION FIELD DATA g.p.m. Nitrate .989 mg-/L Other bacteria 0 Collected by:. MEA g.p,m, Tanksize 1 ¢ 000 Numberof Compartments 2 Cleanouts (Y/N)_y Y Depression (Y/N) N High water alarm (Y/N) N Pumper Construction Date installed 9/1/99 Soil rating (g.p.d./fF or ft2/bdrm) .8 Length 3 6 ' .Width 3 ' Gravel thickness below pipe Effective absorption area 5 ? 6 SF Monitoring Tube present (Y/N) ¥ Date of adequacy test __New C~rm~-: __Results (Pass/Fail) Fluid depth in absorption field before test (in,); __ Fluid depth (ins) Minutes later:. Peroxide treatment (past 12 months) (Y/N) N .System type Deep Trench Total depth_Il,5' _ Depression over field (Y/N) N For Immediately after Absorption rate = If yes, give date gal. water added (in.): g,p.d. N/A bedrooms 72-026 (Rev. 3/96)* F, LIFT BTATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot > 1 0 0 ' Absorption field on lot > 1 0 0 ' Public sewer main N/A Sewer/septic service line > 25 ' Size in gallons "Pump on" level at* "Pump off" level at* On adjacent lots > 1 00 ' On adjacent lots > 100 ' Public sewer manhole/cleanout N/A Lift station N / A Wells on adjacent lots Water main/service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation > 5 ' Property line ;, 5 ' Absorption field Water main/service line > 1 0 ' Surface water/drainage > 1 0 0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ;~ 1 ~) ' Building foundation > 1 0 ' Surface water > 100 ' Curtain drain None Noted on Lot ENGINEER'S CERTIFICATION I certify that I have determined ~ in conformance with MOA HAA guidelines in effect on this date. Signature ~/~-~-ff~ ~~'~ Engineer's Name Mi ~ha~l ~ ~o~n D ~ Date 10/4/99 l~riveway, parking/vehicle storage area Wells on adjacent lots > 1 0 0 ' HAA Fee $, Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number